Issue link: https://viewer.e-digitaledition.com/i/81850
ORTHOPEDIC UPDATE Proper ID, Proper Treatment for Sports Injuries ALTHOUGH THEY RANK AMONG THE MOST COMMON SPORTS- RELATED INJURIES, ANTERIOR CRUCIATE LIGAMENT (ACL), MEDIAL COLLATERAL LIGAMENT (MCL), AND MENISCUS INJURIES ARE OFTEN MISDIAGNOSED AND/OR PERPETUATED. TO ACHI EVE TIME LY DIAGNOSIS and treat- ment, Victor Khabie, M.D. , FA AOS, FACS, Chief of the Department of Surgery, Co-Director of the Orthopedic and Spine Institute and Chief of Sports Medicine at Northern Westchester Hospital, stresses the importance of physicians and athletic coaches recognizing the signs of each injury and knowing when it is appropriate to refer to a specialist. According to Dr. Khabie, the signa- ture characteristic of an ACL injury is an audible pop in the knee accom- panied by swelling, difficulty walking and an inability to continue certain activities. While MCL and meniscus injuries also result in swelling and pain, athletes may still be able to move and participate, albeit in a diminished capacity. Patients may attempt to treat these injuries at home with propping and icing; however, many find their injuries do not improve. The team of board-certified sports medicine specialists at Northern Westchester Hospital utilizes state-of- the-art, minimally invasive surgical approaches to reconstruct patients' knees. An a l l iance with Burke Rehabilitation provides patients easy access to a premier physical therapy facility and the benefits of a team approach that yields a high standard of care. 'Prehab' and Rehab Although hard to endure for athletes accustomed to overcoming obstacles rapidly, surgical treatment for an ACL injury should not be performed immediately after the injury, according to Dr. Khabie. Instead, he says, surgery should be put off for at least three weeks while the patient undergoes prerehabilitation to restore the knee to as close to preinjury status as possible. However, he adds, those three weeks can be made up during postsurgical rehabilitation when necessary. When done before surgery, rehabilitation reduces swelling and the chances of scar tissue and muscle atrophy develop- ing after surgery. "If you take a knee that is swollen, stiff and atrophied and subject it to an operation, the knee reacts as though it's another injury," Dr. Khabie says. "It's like a one-two punch in a boxing match, and the knee tends not to rebound as quickly. If you give it more time to heal from the first injury and then subject it to surgery, it has a much better capacity to rebound from the second 'injury.'" Dr. Khabie notes postsurgical reha- bilitation for ACL reconstruction typically lasts between six months and one year and focuses on regaining strength, reflexes and other protective mechanisms such as proprioception — the feedback from nerve endings that gives the patient a sense of where the knee is in relation to the rest of the body. It is during this six- to 12-month period that the athlete and physician must take their time and allow the injury to heal. Although some athletes have ideas regarding the nature of their inju- ries before consulting a physician, Dr. Khabie emphasizes the impor- tance of thorough evaluation before beginning treatment. "Every injury is unique," he says. "Treatments are very specific and tailor- made to the injury and to the athlete." For more informat ion about the Or thopedic and Spine Inst itute at Northern Westchester Hospital, visit www.nwhorthoandspine.org. ■ Victor Khabie, M.D., FAAOS, FACS 12 | Mid Hudson MD NEWS ■ MDNEWS.COM +++++++++++++++++++++++++++ +++ +++++++++++++++++++++++++++ +++ + +